Please click below on the link to
download the paperwork you will need to bring with you to your
appointment for a neuropsychological exam. :
OR ADOLESCENT PSYCHOLOGICAL/NEUROPSYCHOLOGICAL
Before televideo meetings, please click on the #1 Combined New
Patient Information form, or use the #2 Televideo consent form
only (for Dr. Azrin or Dr. Millsaps) if you have already filled
out the New Patient Information form.
Please click on the Release to give us a release to contact your
referral doctor, other doctors, or any family/friends you would like
us to be able to speak to:
#1 Combined New
Patient Information, Release of Information, and Televideo consent
Azrin Televideo Consent form only
#2 Dr. Millsaps
Televideo Consent form only
Release of Information Form Only
is not the form you need for a gastric bypass
or lap band evaluation.
If you need a gastric bypass or
lap band form,
click here instead.